MAUDE Adverse Event Report: NAKANISHI INC. NSK; HANDPIECE, ROTARY BONE CUTTING

Model Number SGA-E2S

Device Problems Overheating of Device (1437); Temperature Problem (3022)

Patient Problems Burn(s) (1757); Injury (2348)

Event Date 07/01/2015

Event Type  Injury  

Manufacturer Narrative

(b)(4).- nsk america corp.Is listed here in and mr.(b)(6) because mr.(b)(6) is the official correspondent of both (b)(4).Nakanishi is currently trying to obtain further information about the event and patient.

Event Description

On (b)(6) 2018, nakanishi received an e-mail from a distributor (nsk america) about a handpiece overheating.According to nsk america (nam), the information was provided through the adverse event questionnaire about the sgs/sga handpieces as a part of recall activities for those devices.The details are as follows.The event occurred in (b)(6) 2015.(the exact date is unknown.) a dentist was performing a dental procedure using the sga-e2s handpiece (serial no.Unknown).During the procedure, the handpiece overheated and burned a patient's lip.

Manufacturer Narrative

Nsk america (nam) took the following actions, but further information about the event and patient was not provided by the dentist.- on december 14, 2018, nam made a phone call to the dental office and left a message.- on january 29, 2019, nam made another phone call to the dentist and left a message.- on may 28, 2019, nam sent an e-mail to the dentist.

• Brand Name: NSK
• Type of Device: HANDPIECE, ROTARY BONE CUTTING
• Manufacturer (Section D): NAKANISHI INC.; 700 shimohinata; kanuma-shi, tochigi-ken 322-8 666; JA 322-8666
• MDR Report Key: 8229060
• MDR Text Key: 132497331
• Report Number: 9611253-2019-00001
• Device Sequence Number: 1
• Product Code: KMW
• Combination Product (y/n): N
• PMA/PMN Number: K171155
• Number of Events Reported: 1
• Summary Report (Y/N): N
• Report Source: Manufacturer
• Source Type: distributor
• Remedial Action: Recall
• Type of Report: Initial,Followup
• Report Date: 12/18/2018,07/10/2019

1 Device was Involved in the Event

1 Patient was Involved in the Event

• Date FDA Received: 01/08/2019
• Is this an Adverse Event Report?: Yes
• Is this a Product Problem Report?: Yes
• Device Operator: Health Professional
• Device Model Number: SGA-E2S
• Device Catalogue Number: H265
• Was Device Available for Evaluation?: No
• Event Location: Outpatient Treatment Facility
• Date Report to Manufacturer: 12/18/2018
• Date Manufacturer Received: 06/13/2019
• Is This a Reprocessed and Reused Single-Use Device?: No
• Removal/Correction Number: 9611253-060818-001-R
• Patient Sequence Number: 1
• Patient Outcome(s): Other